Clinical application of a free radial artery superficial palmar branch flap for soft-tissue reconstruction of digital injuries.

Unsuccessful reconstruction of injured fingers can lead to poor outcomes. The aim of this article was to investigate the clinical application of the radial artery superficial palmar branch flap for soft-tissue reconstruction of the finger. We treated 125 patients with various finger injuries who underwent free radial artery superficial palmar branch flap reconstruction between October 2010 and March 2015. There were 46 distal finger injuries, 25 distal finger amputation following failed replantation and 54 palmar digital injuries with tendon, bone or joint exposure requiring soft-tissue reconstruction. Of the 125 cases, 114 flap reconstructions were considered successful. We believe that a free radial artery superficial palmar branch flap transfer is credible and useful for reconstructing various finger injuries. LEVEL OF EVIDENCE: III.

Modified anterograde pedicle advancement flap in fingertip injury.

Soft tissue reconstruction is needed to maintain the maximum length of the fingers in fingertip injury. The purpose of this study was to present an anterograde pedicle advancement flap technique, for the treatment of fingertip injuries, which involved a modification to the anterograde advancement flap by the dissection of the digital nerve and artery with a pedicle to advance the flap. This technique was used in 12 fingers in patients who had undergone soft tissue reconstruction of fingertip injuries between January 2012 and October 2013. The sizes of the flaps ranged from 8 × 7 mm to 14 × 10 mm. The mean length of advancement was 9.7 mm (range 7-13). The mean value of the static two-point discrimination test of the healed flaps was 5.1 mm (range 4-6) and the flaps survived in all the 12 cases. The modified anterograde pedicle advancement flap provides a reliable coverage of sensate soft tissue without bone shortening in fingertip injuries.Level II.

Comparison of three-dimensional isotropic and conventional MR arthrography with respect to the diagnosis of rotator cuff and labral lesions: focus on isotropic fat-suppressed proton density and VIBE sequences.

AIM: To compare the diagnostic accuracies of three-dimensional (3D) isotropic magnetic resonance arthrography (MRA) using fat-suppressed proton density (PD) or volume interpolated breath-hold examination (VIBE) sequences with that of conventional MRA for the diagnosis of rotator cuff and labral lesions. MATERIALS AND METHODS: Eighty-six patients who underwent arthroscopic surgery were included. 3D isotropic sequences were performed in the axial plane using fat-suppressed PD (group A) in 53 patients and using VIBE (group B) in 33 patients. Reformatted images were obtained corresponding to conventional images, and evaluated for the presence of labral and rotator cuff lesions using conventional and 3D isotropic sequences. The diagnostic performances of each sequence were determined using arthroscopic findings as the standard. RESULTS: Good to excellent interobserver agreements were obtained for both 3D isotropic sequences for the evaluation of rotator cuff and labral lesions. Excellent agreement was found between two-dimensional (2D) and 3D isotropic MRA, except for supraspinatus tendon (SST) tears by both readers and for subscapularis tendon (SCT) tears by reader 2 in group B. 2D MRA and 3D isotropic sequences had high diagnostic performances for rotator and labral tears, and the difference between the two imaging methods was insignificant. CONCLUSIONS: The diagnostic performances of 3D isotropic VIBE and PD sequences were similar to those of 2D MRA.

A dual anteroposterior approach to the Bernese periacetabular osteotomy.

When the Bernese periacetabular osteotomy is performed through an anterior approach, the ischial and retroacetabular osteotomies and manual fracture of the incompletely osteotomized ischium are conducted with an incomplete view resulting in increased risk and morbidity. We have assessed the dual anteroposterior approach which appears to address this deficiency. We compared the results of the Bernese periacetabular osteotomy performed in 11 patients (13 osteotomies) through a single anterior approach with those in 12 patients (13 osteotomies) in whom the procedure was carried out through a dual anteroposterior approach. The estimated blood loss, the length of anaesthesia, duration of surgery and radiological parameters were measured. The mean operative time and length of anaesthesia were not significantly different in the two groups (p = 0.781 and p = 0.698, respectively). The radiological parameters improved to a similar extent in both groups after the operation but there was significantly less blood loss in the dual osteotomy group (p = 0.034). The dual anteroposterior approach provides a direct view of the retroacetabular and ischial parts of the osteotomy, within a reasonable operating time and with minimal blood loss and gives a satisfactory outcome.

Plasma ghrelin levels and their relationship with gastric emptying in patients with dysmotility-like functional dyspepsia.

BACKGROUND/AIMS: Ghrelin affects gastric motility. However, little is known about the role of ghrelin in the pathophysiology of functional dyspepsia (FD). We investigated plasma ghrelin levels and their relationship with gastric emptying time in dysmotility-like FD patients. METHODS: 42 patients with dysmotility-like FD and 14 healthy volunteers were enrolled in the study. Gastric half-emptying time was measured using a radiolabeled meal. Plasma total ghrelin levels before and after the meal were determined using a radioimmunoassay kit. RESULTS: Preprandial ghrelin levels were significantly lower in FD patients than in controls. Postprandial ghrelin levels were similar between the two groups. Abnormally low preprandial ghrelin levels were observed in 7 out of 42 patients, in whom significant postprandial decrease of ghrelin levels was absent. Delayed gastric emptying was observed in 5 out of 7 patients with abnormally low ghrelin levels. Pre- or postprandial ghrelin levels were not significantly correlated with gastric half-emptying time, both in the patient group and in the control group. CONCLUSIONS: Abnormally low preprandial ghrelin levels and absence of significant postprandial decrease of ghrelin levels are present in a subset of dysmotility-like FD patients. Further investigation on the pathogenetic implication of these alterations in FD is required.

The use of the supraclavicular fossa portal in arthroscopic rotator cuff repair.

SUMMARY: Advances in arthroscopic technology allow rotator cuff repair through a minimally invasive approach. However, fixation of the rotator cuff tendon to suture anchors can be tedious and time consuming. The supraclavicular fossa portal allows improved access to the tear for passing suture. The authors describe the relevant anatomy, positioning, and surgical technique for use of the supraclavicular fossa portal to simplify arthroscopic rotator cuff repair.